Chronic Kidney Disease in Pregnancy.

Abstract

With the increasing prevalence of chronic kidney disease (CKD) worldwide, the number of pregnant women with various degrees of renal dysfunction is expected to increase. There is a bidirectional relation between CKD and pregnancy in which renal dysfunction negatively affects pregnancy outcomes, and the pregnancy can have a deleterious impact on various aspects of kidney disease. It has been shown that even mild renal dysfunction can increase considerably the risk of adverse maternal and fetal outcomes. Moreover, data suggest that a history of recovery from acute kidney injury is associated with adverse pregnancy outcomes. In addition to kidney dysfunction, maternal hypertension and proteinuria predispose women to negative outcomes and are important factors to consider in preconception counseling and the process of risk stratification. In this review, we provide an overview of the physiologic renal changes during pregnancy as well as available data regarding CKD and pregnancy outcomes. We also highlight the important management strategies in women with certain selected renal conditions that are seen commonly during the childbearing years. We call for future research on underexplored areas such as the concept of renal functional reserve to develop a potential clinical tool for prognostication and risk stratification of women at higher risk for complications during pregnancy.

PMID- 28863222
OWN - NLM
STAT- In-Process
DA - 20170901
LR - 20170901
IS - 1541-8243 (Electronic)
IS - 0038-4348 (Linking)
VI - 110
IP - 9
DP - 2017 Sep
TI - Chronic Kidney Disease in Pregnancy.
PG - 578-585
LID - 10.14423/SMJ.0000000000000693 [doi]
AB - With the increasing prevalence of chronic kidney disease (CKD) worldwide, the
number of pregnant women with various degrees of renal dysfunction is expected to
increase. There is a bidirectional relation between CKD and pregnancy in which
renal dysfunction negatively affects pregnancy outcomes, and the pregnancy can
have a deleterious impact on various aspects of kidney disease. It has been shown
that even mild renal dysfunction can increase considerably the risk of adverse
maternal and fetal outcomes. Moreover, data suggest that a history of recovery
from acute kidney injury is associated with adverse pregnancy outcomes. In
addition to kidney dysfunction, maternal hypertension and proteinuria predispose
women to negative outcomes and are important factors to consider in preconception
counseling and the process of risk stratification. In this review, we provide an
overview of the physiologic renal changes during pregnancy as well as available
data regarding CKD and pregnancy outcomes. We also highlight the important
management strategies in women with certain selected renal conditions that are
seen commonly during the childbearing years. We call for future research on
underexplored areas such as the concept of renal functional reserve to develop a
potential clinical tool for prognostication and risk stratification of women at
higher risk for complications during pregnancy.
FAU - Koratala, Abhilash
AU - Koratala A
AD - From the Division of Nephrology, Hypertension, and Renal Transplantation,
University of Florida, Gainesville.
FAU - Bhattacharya, Deepti
AU - Bhattacharya D
AD - From the Division of Nephrology, Hypertension, and Renal Transplantation,
University of Florida, Gainesville.
FAU - Kazory, Amir
AU - Kazory A
AD - From the Division of Nephrology, Hypertension, and Renal Transplantation,
University of Florida, Gainesville.
LA - eng
PT - Journal Article
PL - United States
TA - South Med J
JT - Southern medical journal
JID - 0404522
EDAT- 2017/09/02 06:00
MHDA- 2017/09/02 06:00
CRDT- 2017/09/02 06:00
AID - 10.14423/SMJ.0000000000000693 [doi]
AID - SMJ50421 [pii]
PST - ppublish
SO - South Med J. 2017 Sep;110(9):578-585. doi: 10.14423/SMJ.0000000000000693.